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Association Between Mortality and Levels of Autonomous Cortisol Secretion by Adrenal Incidentalomas : A Cohort Study

Kjellbom, Albin LU orcid ; Lindgren, Ola LU ; Puvaneswaralingam, Shobitha ; Löndahl, Magnus LU and Olsen, Henrik LU orcid (2021) In Annals of Internal Medicine 174(8). p.1041-1049
Abstract

BACKGROUND: Autonomous cortisol secretion in patients with adrenal incidentalomas is associated with increased mortality, but detailed information about the risk associated with specific levels of autonomous cortisol secretion is not available.

OBJECTIVE: To measure the association between mortality and levels of autonomous cortisol secretion in patients with adrenal incidentalomas.

DESIGN: Retrospective cohort study. (ClinicalTrials.gov: NCT03919734).

SETTING: Two hospitals in southern Sweden.

PATIENTS: Consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 and were followed for up to 14 years. Outcome data were collected from national registers.

MEASUREMENTS: Patients were... (More)

BACKGROUND: Autonomous cortisol secretion in patients with adrenal incidentalomas is associated with increased mortality, but detailed information about the risk associated with specific levels of autonomous cortisol secretion is not available.

OBJECTIVE: To measure the association between mortality and levels of autonomous cortisol secretion in patients with adrenal incidentalomas.

DESIGN: Retrospective cohort study. (ClinicalTrials.gov: NCT03919734).

SETTING: Two hospitals in southern Sweden.

PATIENTS: Consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 and were followed for up to 14 years. Outcome data were collected from national registers.

MEASUREMENTS: Patients were grouped according to plasma cortisol level after a 1-mg dexamethasone suppression test (cortisolDST; <50, 50 to 82, 83 to 137, or ≥138 nmol/L).

RESULTS: During a median follow-up of 6.4 years, 170 of 1048 patients died. Compared with a cortisolDST less than 50 nmol/L, a cortisolDST of 50 to 82 nmol/L was not associated with increased mortality (hazard ratio [HR], 1.15 [95% CI, 0.78 to 1.70]). However, a cortisolDST of 83 to 137 nmol/L (n = 119) had an HR of 2.30 (CI, 1.52 to 3.49), and a cortisolDST of 138 nmol/L or higher (n = 82) had an HR of 3.04 (CI, 1.86 to 4.98). Analyses using restricted cubic splines indicated that the association between cortisolDST and mortality was linear up to a cortisolDST of 200 nmol/L.

LIMITATION: The results are not based on verified autonomous cortisol secretion; thus, the association may be underestimated.

CONCLUSION: The association between mortality and cortisolDST increased linearly until cortisolDST reached 200 nmol/L. A cortisolDST of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisolDST of 138 nmol/L or higher was associated with a 3-fold increase in mortality. Additional studies should be done, and until those studies are completed some clinicians may consider these findings when deciding which patients to recommend for surgery.

PRIMARY FUNDING SOURCE: Lisa and Johan Grönberg Foundation and Gyllenstiernska Krapperup Foundation.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Internal Medicine
volume
174
issue
8
pages
1041 - 1049
publisher
American College of Physicians
external identifiers
  • scopus:85114385179
  • pmid:34029490
ISSN
0003-4819
DOI
10.7326/M20-7946
language
English
LU publication?
yes
id
d019cffe-77d0-4537-b653-62050fd5bb8e
date added to LUP
2021-08-14 14:15:19
date last changed
2024-07-13 16:42:50
@article{d019cffe-77d0-4537-b653-62050fd5bb8e,
  abstract     = {{<p>BACKGROUND: Autonomous cortisol secretion in patients with adrenal incidentalomas is associated with increased mortality, but detailed information about the risk associated with specific levels of autonomous cortisol secretion is not available.</p><p>OBJECTIVE: To measure the association between mortality and levels of autonomous cortisol secretion in patients with adrenal incidentalomas.</p><p>DESIGN: Retrospective cohort study. (ClinicalTrials.gov: NCT03919734).</p><p>SETTING: Two hospitals in southern Sweden.</p><p>PATIENTS: Consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 and were followed for up to 14 years. Outcome data were collected from national registers.</p><p>MEASUREMENTS: Patients were grouped according to plasma cortisol level after a 1-mg dexamethasone suppression test (cortisolDST; &lt;50, 50 to 82, 83 to 137, or ≥138 nmol/L).</p><p>RESULTS: During a median follow-up of 6.4 years, 170 of 1048 patients died. Compared with a cortisolDST less than 50 nmol/L, a cortisolDST of 50 to 82 nmol/L was not associated with increased mortality (hazard ratio [HR], 1.15 [95% CI, 0.78 to 1.70]). However, a cortisolDST of 83 to 137 nmol/L (n = 119) had an HR of 2.30 (CI, 1.52 to 3.49), and a cortisolDST of 138 nmol/L or higher (n = 82) had an HR of 3.04 (CI, 1.86 to 4.98). Analyses using restricted cubic splines indicated that the association between cortisolDST and mortality was linear up to a cortisolDST of 200 nmol/L.</p><p>LIMITATION: The results are not based on verified autonomous cortisol secretion; thus, the association may be underestimated.</p><p>CONCLUSION: The association between mortality and cortisolDST increased linearly until cortisolDST reached 200 nmol/L. A cortisolDST of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisolDST of 138 nmol/L or higher was associated with a 3-fold increase in mortality. Additional studies should be done, and until those studies are completed some clinicians may consider these findings when deciding which patients to recommend for surgery.</p><p>PRIMARY FUNDING SOURCE: Lisa and Johan Grönberg Foundation and Gyllenstiernska Krapperup Foundation.</p>}},
  author       = {{Kjellbom, Albin and Lindgren, Ola and Puvaneswaralingam, Shobitha and Löndahl, Magnus and Olsen, Henrik}},
  issn         = {{0003-4819}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{8}},
  pages        = {{1041--1049}},
  publisher    = {{American College of Physicians}},
  series       = {{Annals of Internal Medicine}},
  title        = {{Association Between Mortality and Levels of Autonomous Cortisol Secretion by Adrenal Incidentalomas : A Cohort Study}},
  url          = {{http://dx.doi.org/10.7326/M20-7946}},
  doi          = {{10.7326/M20-7946}},
  volume       = {{174}},
  year         = {{2021}},
}